| NPI | 1437299468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 49953) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101233275) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2019-03-13 |