| NPI | 1922081397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 17991) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2013-05-13 |