| NPI | 1407077407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N9275) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101016636) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2011-10-07 |