| NPI | 1659661908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R0359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.207048) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2017-03-15 |