| NPI | 1043633233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T0740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-09238) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2022-07-26 |