| NPI | 1093718462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P4661) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A63649) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2016-12-01 |