| NPI | 1366450181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 054246) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 48544) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-05-20 |