| NPI | 1881184901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T1091) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 69622) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2022-12-20 |