| NPI | 1235180704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 23812) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 23812) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2012-04-09 |