| NPI | 1487634481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 36642) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 85363) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2021-08-24 |