| NPI | 1801152152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P9187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10043538) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2019-01-08 |