| NPI | 1720656333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0073717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12201) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2024-07-23 |