| NPI | 1124409719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A18765) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO TL.0005718) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2023-01-19 |