| NPI | 1861055147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T7533) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10067167) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2023-01-20 |