| NPI | 1134199714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 77771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q0686) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2022-07-21 |