| NPI | 1710952668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N1281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01060293A) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2015-03-04 |