| NPI | 1972549061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3602) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 050697) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2010-12-17 |