| NPI | 1912108234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX p4735) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301089645) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-03-09 |