| NPI | 1518186451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P1191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2009017561) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2016-11-28 |