| NPI | 1285194431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T6005) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 21794) |
| 207R00000X Internal Medicine (Licence: NV LL3274) | |
| 207R00000X Internal Medicine (Licence: FL ME155781) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-08-10 |