| NPI | 1568846640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R5585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125066638) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2023-09-01 |