| NPI | 1073582029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L3368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200200040) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-09-29 |