| NPI | 1528325586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6237) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 48292) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2017-12-19 |