| NPI | 1679033104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND PT19091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T8749) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2022-12-23 |