| NPI | 1861650202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0058968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME112573) |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2022-07-21 |