| NPI | 1215005947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R4994) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200700630) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2018-04-12 |