| NPI | 1881114932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0070393) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019019439) |
| 208D00000X General Practice (Licence: MO 2019019439) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2023-06-26 |