| NPI | 1467863522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR0059168) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206408) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2017-09-26 |