| NPI | 1043273790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L7578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 20020178) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2015-05-28 |