| NPI | 1174534796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 40540) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO 40540) |
| 207RA0000X Internal Medicine Adolescent Medicine (Licence: CO 40540) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2015-01-29 |