| NPI | 1235546540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S6025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 66504) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2023-05-24 |