| NPI | 1700181328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR0067617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q7012) |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2022-09-29 |