| NPI | 1730674144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T7776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301116099) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-12-30 |