| NPI | 1831186030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P8086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C51826) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2019-10-08 |