| NPI | 1760523609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R2373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00020421) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2019-10-11 |