| NPI | 1831350461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P0277) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 42185) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2014-04-28 |