| NPI | 1073991915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 10476493-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R74955) |
| 207R00000X Internal Medicine (Licence: UT 10476493-8905) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2018-06-21 |