| NPI | 1508120585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R3865) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 56575) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2019-05-29 |