| NPI | 1366430076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M2671) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 028345) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2014-03-31 |