| NPI | 1003967100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 74076) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101052100) |
| 207R00000X Internal Medicine (Licence: DC 20129) | |
| 207R00000X Internal Medicine (Licence: TX M8022) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2014-02-11 |