| NPI | 1114182003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0055553) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT193408) |
| 207R00000X Internal Medicine (Licence: PA MD443064) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2015-10-16 |