| NPI | 1689917700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD189138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0057172) |
| 207R00000X Internal Medicine (Licence: TX R1070) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2019-11-08 |