| NPI | 1366750630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P9271) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD443326) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2015-02-18 |