| NPI | 1073715496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX m9420) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 4566) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2009-08-21 |