| NPI | 1669421301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 44561) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 27765) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2018-03-17 |