| NPI | 1902008196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T1031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.117795) |
| 207R00000X Internal Medicine (Licence: WI 70397) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2021-06-24 |