| NPI | 1508206095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S4431) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 302339) |
| 207R00000X Internal Medicine (Licence: VA 0102204149) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-08-10 |