| NPI | 1891754248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 45496) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101013785) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2021-06-14 |