| NPI | 1982967923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q3307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2012018827) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2021-02-02 |