| NPI | 1316086317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M9576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 2004-0381) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2009-06-25 |