| NPI | 1255707386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 64993) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052367) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2023-09-13 |