| NPI | 1639599608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 25137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10048759) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2022-07-21 |