| NPI | 1639530173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1428) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10050253) |
| 207R00000X Internal Medicine (Licence: MN 68999) | |
| 207R00000X Internal Medicine (Licence: IA DO-05586) | |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2021-05-05 |