| NPI | 1376645002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P4761) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301037942) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2018-05-02 |