| NPI | 1033242680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 075115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX M2006) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-10-22 |