| NPI | 1922046622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L2580) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00041144) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2019-05-23 |