| NPI | 1255792784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A16368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 593150) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2018-08-22 |