| NPI | 1922304195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 51132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT193877) |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2020-10-15 |