| NPI | 1366584070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N4309) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 152971) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-12-08 |