| NPI | 1295720746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S9886) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME126279) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2021-03-31 |