| NPI | 1922147941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T0359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 2004-0508) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2023-08-15 |