| NPI | 1154843449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME141920) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S6443) |
| 207R00000X Internal Medicine (Licence: LA 332851) | |
| Enumeration Date | 2017-07-09 |
| Last Update Date | 2022-08-16 |