| NPI | 1376771915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N3595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 253656) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2013-05-09 |