| NPI | 1154841955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T5029) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 272344) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-22 |