| NPI | 1588227680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS17939) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX U6966) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-06-29 |