| NPI | 1427377456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 10909A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX E4388) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2020-09-30 |