| NPI | 1568424976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 3923A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 27561) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2013-06-07 |