| NPI | 1053390609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME 016935) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0064553) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2020-10-08 |