| NPI | 1497843106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101248298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX M0302) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-05-06 |