| NPI | 1073804019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q1149) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.207046) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2022-04-27 |