| NPI | 1619940459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 44569) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 45316) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-01-08 |