| NPI | 1154503563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 45760) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2016-11-01 |