| NPI | 1417319898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T0921) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 306611) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2022-03-21 |