| NPI | 1144470758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P2716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2008013992) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2012-10-25 |