| NPI | 1780643262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0053285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01060578) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2021-11-05 |