| NPI | 1821135153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 52534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 9801357) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2023-12-04 |