| NPI | 1023691912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO dr.0069402) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO dr.0069402) |
| 208D00000X General Practice (Licence: CO Dr.0069402) | |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2024-03-01 |