| NPI | 1891913679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P3740) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00047771) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-07-21 |