| NPI | 1730170499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 18266) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P7948) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2015-11-17 |