| NPI | 1962542142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 23934) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N0610) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2012-03-15 |