| NPI | 1265772073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R6078) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A131949) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2022-02-01 |