| NPI | 1548413024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 50287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME124905) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2020-09-24 |