| NPI | 1376832105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0057230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015013511) |
| 208000000X Pediatrics (Licence: MO 2015013511) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2021-05-21 |