| NPI | 1952742157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042-0013446) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10047037) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2016-06-30 |