| NPI | 1255315164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J8742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J8742) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2009-01-16 |