| NPI | 1588722912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P8750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 32063) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2019-12-04 |