| NPI | 1285613323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-40980) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00027006) |
| 207R00000X Internal Medicine (Licence: AR E-10536) | |
| 207R00000X Internal Medicine (Licence: TX H4314) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2021-01-26 |