| NPI | 1912034984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME155336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q2710) |
| 207R00000X Internal Medicine (Licence: CO 38479) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2022-10-25 |