| NPI | 1356703060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0063660) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0063660) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-01-05 |