| NPI | 1841238987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 7779053-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 14665) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2012-06-27 |