| NPI | 1861871527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO CDRH.0059607) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0059607) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0005585) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2022-01-04 |