| NPI | 1053346379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M7515) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A45328) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-08-28 |