| NPI | 1689053183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R4978) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10054281) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2019-08-22 |