| NPI | 1609833649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 32285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD19497) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2010-07-12 |