| NPI | 1255560371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S1524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A141029) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2019-06-27 |