| NPI | 1659575215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.205314) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N1297) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2012-12-06 |