| NPI | 1508398652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T7648) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 32924) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2022-08-16 |