| NPI | 1760836407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 79413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T5938) |
| 207R00000X Internal Medicine (Licence: NY 299507) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2024-12-06 |