| NPI | 1720485279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX u0382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 41636) |
| Enumeration Date | 2014-11-28 |
| Last Update Date | 2024-01-26 |