| NPI | 1598116964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 11205153-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10716) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2024-07-11 |