| NPI | 1336529163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 107159381204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067425) |
| Enumeration Date | 2015-06-06 |
| Last Update Date | 2022-04-28 |