| NPI | 1235174723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD154233) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 22387) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2023-08-11 |