| NPI | 1275559049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 44952) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 67091) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-10-31 |