| NPI | 1275768590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N6025) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 253474-1) |
| Enumeration Date | 2009-05-17 |
| Last Update Date | 2015-10-06 |