| NPI | 1144699505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10053699) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2020-05-15 |