| NPI | 1063494839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P4275) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 40283) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2022-10-25 |