| NPI | 1730262478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 42057) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 241472) |
| 207R00000X Internal Medicine (Licence: CO 45217) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-06-25 |