| NPI | 1649427618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q2115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 047615) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2017-05-10 |