| NPI | 1962596353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR 0037400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 20020393) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2013-12-03 |