| NPI | 1013478528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V4923) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.074237) |
| 207R00000X Internal Medicine (Licence: CA A179362) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-01-21 |