| NPI | 1205895331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX H2884) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H2884) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2020-05-13 |