| NPI | 1750492088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K4520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD061924L) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-04-13 |