| NPI | 1295841419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 187979-8017) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 6806A) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2015-08-10 |