| NPI | 1265576987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 27070) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 27070) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2012-11-07 |