| NPI | 1700918034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 46845) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A95799) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2018-10-15 |