| NPI | 1770759862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q2137) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301085576) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2016-10-13 |