| NPI | 1053774844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S5196) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB10492500) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2023-07-18 |