| NPI | 1790149300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX T1118) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD469360) |
| 207R00000X Internal Medicine (Licence: NJ 25MA10541100) | |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2024-09-30 |