| NPI | 1194752485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D69482) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 223371-1) |
| 207R00000X Internal Medicine (Licence: CO 44857) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-07-09 |