| NPI | 1548548373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0059891) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD452950) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2018-04-18 |