| NPI | 1407041395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N3608) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 001933) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2010-01-22 |