| NPI | 1902878291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 32815) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: CO 32815) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2016-06-07 |