| NPI | 1205299922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10055297) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2019-08-19 |