| NPI | 1205006590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N2258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 40841) |
| 207R00000X Internal Medicine (Licence: IL 125-049185) | |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2022-08-12 |