| NPI | 1003074501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR-49424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK 6996) |
| 207R00000X Internal Medicine (Licence: OR MD153299) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2012-02-28 |