| NPI | 1750825931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO198298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO TL.0006418) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2021-11-15 |