| NPI | 1760633036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N5331) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10030999) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2021-12-08 |