| NPI | 1760770234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q2968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 50131) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2019-01-28 |