| NPI | 1639190770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L4200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 21716) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2013-07-25 |