| NPI | 1932307097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q2497) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301083452) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-12-08 |