| NPI | 1134380652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 11014332A) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2014-01-13 |