| NPI | 1609339787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101277833) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 500002408) |
| 207R00000X Internal Medicine (Licence: TX T9494) | |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2023-11-20 |