| NPI | 1104189026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101019942) |
| 207R00000X Internal Medicine (Licence: GA 074006) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2018-01-29 |