| NPI | 1407058423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 40565) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO CDRH.0058074) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2024-11-01 |