| NPI | 1003153214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A152785) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q6858) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2018-06-22 |