| NPI | 1114902111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N7885) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD25273) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2014-04-21 |