| NPI | 1346239548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 11925A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 374653-1205) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2020-10-05 |