| NPI | 1629131974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 47104) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 20020411) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2009-03-24 |