| NPI | 1588983449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 9361788-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 7363) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2021-10-01 |