| NPI | 1699009043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T5474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 067621) |
| 207R00000X Internal Medicine (Licence: FL ME111847) | |
| 207R00000X Internal Medicine (Licence: IL 125.055607) | |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2023-03-10 |