| NPI | 1588168157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T4126) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 47326) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2022-09-02 |