| NPI | 1750302790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 54491) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A69802) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2024-04-03 |