| NPI | 1619067097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 45716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2006-0476) |
| 207R00000X Internal Medicine (Licence: NM R2003-0221) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-02-12 |