| NPI | 1265490544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L6969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 10310) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2014-11-20 |