| NPI | 1174803357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S0833) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098408) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2023-08-24 |