| NPI | 1891146379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 65575) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R4673) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-09-27 |