| NPI | 1215077482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N2363) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 24488) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2015-01-28 |