| NPI | 1801207873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R2619) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS T-2807) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2019-02-25 |