| NPI | 1134419955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX Q2906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10037433) |
| 2085R0001X (Licence: FL 15881) | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2016-03-04 |