| NPI | 1902867260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J2277) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD17498) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2020-10-30 |