| NPI | 1457361172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0054301) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 042-00010678) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2015-07-24 |