| NPI | 1235349192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 6581453-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-7273) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-06-08 |