| NPI | 1013349414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R2241) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS018094) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2022-04-12 |