| NPI | 1316391584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102205946) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10056500) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2021-09-09 |