| NPI | 1770917759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 26994) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V2074) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2024-07-18 |