| NPI | 1821389636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q0217) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10039978) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2014-09-09 |