| NPI | 1104980291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 51505) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT185859) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2013-07-22 |