| NPI | 1861984916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T0608) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 276393) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2022-12-20 |