| NPI | 1750540522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 8256897-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 42180) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2024-11-05 |