| NPI | 1255714820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX BP10054230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GU M-2322) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2023-02-07 |