| NPI | 1679768378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N8577) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA TL002810) |
| 207R00000X Internal Medicine (Licence: GA 65314) | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2015-09-15 |