| NPI | 1215257142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125:057968) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2020-09-30 |