| NPI | 1962887943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067872) |
| 207R00000X Internal Medicine (Licence: TX R9859) | |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2026-05-20 |