| NPI | 1053544122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P3170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL U02275) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2022-04-01 |