| NPI | 1598992570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 9894312-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102202659) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2017-04-17 |