| NPI | 1902005523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N7342) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL me100577) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2013-06-03 |