| NPI | 1750816161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 11782249-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76101) |
| Enumeration Date | 2017-04-23 |
| Last Update Date | 2020-06-03 |