| NPI | 1255537429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 8715379-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 24913) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2013-10-10 |