| NPI | 1174784516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 279854) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P0287) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2015-06-01 |