| NPI | 1023423472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0067752) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO FS6358685) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-04-27 |