| NPI | 1649669136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U7887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301110962) |
| 207R00000X Internal Medicine (Licence: KY 48656) | |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2024-01-12 |