| NPI | 1790126092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX q7901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125-063625) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2024-12-10 |