| NPI | 1750376703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J6507) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX J6507) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2011-10-12 |