| NPI | 1467728576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J8987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 19196) |
| 207R00000X Internal Medicine (Licence: OK 22718) | |
| 207R00000X Internal Medicine (Licence: CA G46408) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-03-23 |