| NPI | 1679647036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 11335) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G57973) |
| 207R00000X Internal Medicine (Licence: CO 37499) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2017-05-19 |