| NPI | 1336109362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2013-00770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K4386) |
| 207R00000X Internal Medicine (Licence: MI 4301099784) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2018-03-17 |