| NPI | 1881906790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R7656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 052020) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2021-10-06 |