| NPI | 1679924781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T7011) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068409) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2023-02-28 |