| NPI | 1003924101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L3285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 222240) |
| 207R00000X Internal Medicine (Licence: LA 15025R) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2011-08-10 |