| NPI | 1700217411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 353886) |
| Enumeration Date | 2013-12-05 |
| Last Update Date | 2022-07-21 |