| NPI | 1003850066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0054913) |
| Additional Taxonomies | 193400000X Single Specialty (Licence: CO DR.0054913) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-02-10 |