| NPI | 1710279922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 8975811-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID MC-1184) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2022-01-24 |