| NPI | 1508244799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R9805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 72282) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2020-10-08 |