| NPI | 1023402252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX BP10052373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60862146) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2024-01-02 |