| NPI | 1639531098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.75706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2019-00434) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2026-01-14 |