| NPI | 1477534154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0037159) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CO 37159) |
| 207Q00000X Family Medicine (Licence: CO 37159) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2021-01-05 |