| NPI | 1639158470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX G5282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2003018928) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-05-14 |