| NPI | 1194794610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N9300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036091485) |
| 207R00000X Internal Medicine (Licence: MN 43570) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2020-01-15 |