| NPI | 1801470299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U0083) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P10075593) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2023-05-02 |