| NPI | 1558658773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P9305) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.059425) |
| 207R00000X Internal Medicine (Licence: FL ME150208) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2022-01-13 |