| NPI | 1679573299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M4025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 18726) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2022-12-06 |