| NPI | 1811999014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M4920) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 047937) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2013-06-20 |