| NPI | 1578520458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P4298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01056530A) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2017-11-20 |