| NPI | 1558858092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD207084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10064705) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2021-10-14 |