| NPI | 1154732030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R5948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10050812) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2019-11-27 |