| NPI | 1588864151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 59077) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 46353) |
| 207R00000X Internal Medicine (Licence: CO 49638) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2015-11-10 |