| NPI | 1053568592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 7929795-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101017699) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2023-11-27 |