| NPI | 1699126763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T8621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A163271) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2022-10-20 |