| NPI | 1578513693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0065126) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 35867) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-08-17 |