| NPI | 1669604062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GU M-2076) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N4722) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2023-12-19 |