| NPI | 1265746457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM CS00218795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10036945) |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2013-08-04 |