| NPI | 1558772533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 13716859-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV SL1023) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2024-04-23 |