| NPI | 1639135031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0038776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 21830) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2025-02-07 |