| NPI | 1255727152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72331) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0060795) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-08-15 |