| NPI | 1396163010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 65916) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX s4315) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-07-19 |