| NPI | 1548765654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U6573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 5919) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-10-12 |