| NPI | 1760541627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: TX F9125) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F9125) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2009-05-15 |