| NPI | 1124227608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P9654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 10622) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2018-11-26 |