| NPI | 1578941308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R2500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Bp10054297) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2023-04-27 |