| NPI | 1477741353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N1827) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP1-0022254) |
| 208D00000X General Practice (Licence: TX N1827) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2021-08-17 |