| NPI | 1720306830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0059433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60000000) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2021-03-22 |