| NPI | 1386922771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U9040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME160086) |
| 207R00000X Internal Medicine (Licence: MI 4301099331) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2024-06-04 |