| NPI | 1972577013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J6037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36093058) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-05-08 |