| NPI | 1821075821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0059540) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 43458) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2021-09-30 |