| NPI | 1871013755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 282254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V1652) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-12-31 |