| NPI | 1518493444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 282143) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10060875) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-06-17 |