| NPI | 1760713424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N8309) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0071245) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2023-06-13 |