| NPI | 1770542177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 50758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 05010645L) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-06-23 |