| NPI | 1477944130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U0796) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 1554) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2024-07-25 |