| NPI | 1306425350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 60594) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0072907) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2026-06-12 |