| NPI | 1841693728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 11763976-1205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18877) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2020-06-03 |