| NPI | 1013954320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-11587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 46838-020) |
| 207R00000X Internal Medicine (Licence: TX P1964) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2018-09-10 |