| NPI | 1528174018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0036503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 051788) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-06-14 |