| NPI | 1720394992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S2525) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 15236) |
| 207R00000X Internal Medicine (Licence: IL 125057321) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2020-06-02 |