| NPI | 1316026016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 48519) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 13400) |
| 207R00000X Internal Medicine (Licence: TX P2682) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2015-10-12 |