| NPI | 1811018294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P5229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME94593) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2021-09-16 |