| NPI | 1962769885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S6876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 292109) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2021-08-02 |