| NPI | 1932195369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0061548) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101259966) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2020-02-06 |