| NPI | 1134660400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0062724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO TL.0006401) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2020-07-07 |