| NPI | 1700237617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S8138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 267144) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2020-09-15 |