| NPI | 1174974059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 11195809-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-10678) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2020-12-22 |