| NPI | 1114123411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M7767) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 221614) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2012-12-13 |