| NPI | 1811085723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 34177) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD27017) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2016-01-08 |