| NPI | 1568449742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT 29585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0056916) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2019-05-02 |