| NPI | 1144634809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T1814) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME146050) |
| 207R00000X Internal Medicine (Licence: MI 4301105924) | |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2021-09-01 |