| NPI | 1093205197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T0694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10063736) |
| 208D00000X General Practice (Licence: TX T0694) | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2022-01-25 |