| NPI | 1558885343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 12653832-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 29238) |
| 207R00000X Internal Medicine (Licence: MN 66295) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-04-21 |