| NPI | 1629084454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P2196) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00045781) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-01-15 |