| NPI | 1003074790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD463978) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 50013) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2020-10-01 |