| NPI | 1154586105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD168027) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 50469) |
| 207R00000X Internal Medicine (Licence: GA 003458) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2023-04-24 |