| NPI | 1376684027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N4642) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 24999) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2022-11-29 |