| NPI | 1114454758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 70913) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S6077) |
| Enumeration Date | 2017-05-14 |
| Last Update Date | 2024-05-22 |