| NPI | 1609852235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX F3704) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX F3704) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2008-08-15 |