| NPI | 1669727046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A17415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10044206) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2021-02-10 |