| NPI | 1689663684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 44297) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 02093) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2010-05-19 |