| NPI | 1871804807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6098) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME115728) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2020-10-09 |