| NPI | 1205939337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N0300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 41628) |
| 207R00000X Internal Medicine (Licence: NY 002639) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2018-02-16 |