| NPI | 1689638561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A9719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F5869) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2013-03-26 |