| NPI | 1235279332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0029633) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 29633) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-12-28 |