| NPI | 1356667612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q2242) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 8767238-1205) |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2022-07-21 |