| NPI | 1245771450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 89034) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S6091) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2021-07-28 |