| NPI | 1982681250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 13725834-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 19026) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2024-05-02 |