| NPI | 1497840979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 4631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 3952A) |
| 207R00000X Internal Medicine (Licence: TX D8426) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |