| NPI | 1992948681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P0061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A107124) |
| Enumeration Date | 2009-04-11 |
| Last Update Date | 2011-12-20 |