| NPI | 1639559230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-11249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10053896) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2018-06-14 |