| NPI | 1124589973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T8043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS19175) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2022-09-26 |