| NPI | 1033472170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q9873) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT-202250) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2017-04-25 |