| NPI | 1588896922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q9535) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 050943) |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2021-11-11 |