| NPI | 1932565637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q9586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A16660) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2019-03-18 |