| NPI | 1164804068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S5364) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067713) |
| 207R00000X Internal Medicine (Licence: IN 01080795A) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2020-09-14 |