| NPI | 1770607343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 061638) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2009-01-09 |