| NPI | 1063875342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T0578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD467326) |
| Enumeration Date | 2016-04-03 |
| Last Update Date | 2021-07-30 |