| NPI | 1710299623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T8589) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 27940) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2023-01-11 |