| NPI | 1508096843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 9764006-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID O-0664) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2016-06-29 |