| NPI | 1720225816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N5288) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 001806) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2014-08-15 |