| NPI | 1356628812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 04453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P5509) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2022-12-06 |