| NPI | 1013303734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61122148) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R4628) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2022-01-18 |