| NPI | 1265751044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6015) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 549943) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2020-10-01 |