| NPI | 1700315280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T4236) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 271744) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-08-03 |