| NPI | 1992798987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N3988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 109020) |
| 207R00000X Internal Medicine (Licence: KS 04-26572) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2021-05-14 |