| NPI | 1295927580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N7031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD27713) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2011-03-21 |