| NPI | 1174595607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0070831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 38234) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2023-07-25 |