| NPI | 1285989327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q5453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT202787) |
| Enumeration Date | 2012-07-15 |
| Last Update Date | 2022-02-17 |