| NPI | 1912108754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A117166) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10022690) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2019-01-28 |