| NPI | 1922548890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S4596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2022-0847) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2024-12-30 |