| NPI | 1952390338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 52693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L4594) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2012-02-29 |