| NPI | 1336432012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301116344) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P9953) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2018-11-07 |