| NPI | 1740692904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R3577) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10050126) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2017-11-03 |