| NPI | 1861923401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U3791) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 20197) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2023-10-05 |