| NPI | 1730617044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U2659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61036881) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2023-10-24 |