| NPI | 1558416560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 57812) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 2892A) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2018-08-31 |