| NPI | 1487650487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N4060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00043381) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2021-04-29 |