| NPI | 1760458640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M4823) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 18190) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2013-01-25 |