| NPI | 1003053638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 37392) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G29929) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2009-01-20 |