| NPI | 1235120643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-13475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F7264) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2007-07-08 |