| NPI | 1861748089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q3483) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200771) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2021-01-08 |