| NPI | 1720349814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 9337452-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125:061197) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2016-05-12 |