| NPI | 1235195728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX F7388) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX F7388) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2015-10-27 |