| NPI | 1245689215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R8847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI EMC0002716) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-12-13 |