| NPI | 1447512553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 0054711) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101020095) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2021-06-04 |