| NPI | 1417996067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 33716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 43205) |
| 207R00000X Internal Medicine (Licence: NM 98-71) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2008-10-06 |