| NPI | 1023298189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N6434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME114690) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2021-06-04 |