| NPI | 1497335178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0074916) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CO DR.0074916) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2025-07-01 |