| NPI | 1801846068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L5514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102049959) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2022-01-27 |