| NPI | 1477890614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315060922) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2022-07-21 |