| NPI | 1649212291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME 017619) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L3486) |
| 207P00000X Emergency Medicine (Licence: KY 36412) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2016-04-09 |