| NPI | 1780029215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 17568A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM A-2145-18) |
| 207R00000X Internal Medicine (Licence: TX R2778) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2024-10-31 |