| NPI | 1164717070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P8994) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2011016937) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2016-02-09 |