| NPI | 1619086493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 4791468-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 10098) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-03-18 |