| NPI | 1619111531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 15535) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A116166) |
| 207R00000X Internal Medicine (Licence: TX P8371) | |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2015-03-03 |