| NPI | 1659638898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6909) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 29108) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2019-11-01 |