| NPI | 1124125000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M4037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD436942) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-09-10 |