| NPI | 1982988697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q7258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 276113) |
| 207R00000X Internal Medicine (Licence: CT 052770) | |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2016-07-01 |