| NPI | 1457643876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q3418) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.207137) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2017-03-02 |