| NPI | 1811276686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q4514) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10039785) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2015-07-08 |