| NPI | 1821471327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U2802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016669) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2023-05-16 |