| NPI | 1184036378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018939) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10050128) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2019-09-23 |