| NPI | 1750744629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AK 190618) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101262988) |
| 207R00000X Internal Medicine (Licence: TX S4498) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2022-09-27 |