| NPI | 1275580599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N6079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 33845) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2011-05-10 |