| NPI | 1720088636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX H7748) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR C7276) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2019-12-31 |