| NPI | 1780670315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K9522) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 14985) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2018-03-15 |