| NPI | 1275065559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S5613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT212860) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-09-16 |