| NPI | 1407143100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 13244411-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 10289A) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2023-03-23 |