| NPI | 1265463756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 47320) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 99021118A) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-05-11 |