| NPI | 1679863930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD211332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0054109) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2022-08-29 |