| NPI | 1710398615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD188621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2017031977) |
| 207R00000X Internal Medicine (Licence: TX R7946) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2022-06-20 |