| NPI | 1720500929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME144861) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 25288) |
| 207R00000X Internal Medicine (Licence: TX S9085) | |
| 207R00000X Internal Medicine (Licence: CA A169713) | |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2024-08-07 |