| NPI | 1952665234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1564) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2015-0541) |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2017-12-07 |