| NPI | 1255642419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01088388A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX p1820) |
| 207R00000X Internal Medicine (Licence: TX P1820) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2022-08-18 |