| NPI | 1366547150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX k3807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G80554) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-12-15 |