| NPI | 1356702419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T6651) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 04368) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2022-06-02 |