| NPI | 1265432645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L5098) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 09329R) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2007-07-14 |