| NPI | 1073593216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 48508) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2006-0198) |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2016-11-23 |