| NPI | 1588612139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0069745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D25062) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-03-23 |