| NPI | 1568791010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P4132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT196206) |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2023-07-20 |