| NPI | 1275658312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX F1361) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F1361) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2013-11-08 |