| NPI | 1932762507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T8777) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10067113) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2022-07-28 |