| NPI | 1588781579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M8102) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT184861) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2014-03-13 |