| NPI | 1366570855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P2386) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101016014) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2012-11-15 |