| NPI | 1780900886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2017-01959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2013-0317) |
| 207R00000X Internal Medicine (Licence: TX R0519) | |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2017-11-15 |