| NPI | 1609134550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q3711) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276938-1) |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2016-03-15 |