| NPI | 1649479494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N9721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11013864A) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2013-07-26 |