| NPI | 1003903139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0061514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD38041) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2025-02-04 |