| NPI | 1245648195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R6365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125064412) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2020-04-24 |