| NPI | 1144515321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R8321) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME128639) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2019-01-07 |