| NPI | 1720280647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N2758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10024721) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2017-08-31 |