| NPI | 1164692570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C149817) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N5759) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2019-09-20 |