| NPI | 1942589205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P4752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A117272) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2012-11-20 |