| NPI | 1043745789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T1332) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60963472) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2022-03-24 |