| NPI | 1790746691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N5437) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 61698) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2013-05-09 |