| NPI | 1629041710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P9791) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME92896) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2015-04-17 |