| NPI | 1710203203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX BP-0036657) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 60503474) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2015-02-20 |