| NPI | 1679881866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0053059) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME114189) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2018-09-06 |