NPI age
14 years
Enumerated 2011-06-20
Across 12343 active internal medicine providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (NJ) | 25MA09345600 | NJ STATE LICENSE |
| 05 (SC) | 368541 | |
| 01 (PA) | MT199651 | GRADUATE MEDICAL TRAINEE LICENSE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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