| NPI | 1942363114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 38574) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD021237E) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2010-05-17 |