| NPI | 1235624354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T8554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018022479) |
| 208D00000X General Practice (Licence: MO 2019036773) | |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2023-02-23 |