| NPI | 1881181618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO TL.0007275) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 12335288-1204) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2021-06-17 |