| NPI | 1760415046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L7566) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-116371) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2012-08-16 |