| NPI | 1356963565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02007080A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10072176) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2023-06-25 |