| NPI | 1912926759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR0053809) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 34291) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-05-15 |