| NPI | 1548222193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N1603) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 238680) |
| 207R00000X Internal Medicine (Licence: MO 2005035770) | |
| 207R00000X Internal Medicine (Licence: PA MD431315) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2011-12-06 |