| NPI | 1427478965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T3417) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60850332) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2021-09-10 |