| NPI | 1235683699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 70545-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10057160) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2021-03-31 |