| NPI | 1972763738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N7453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 241479) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2023-07-18 |