| NPI | 1619114337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0047606) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 224530) |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2022-05-20 |