| NPI | 1992995997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A11360) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N6536) |
| 207R00000X Internal Medicine (Licence: MI 5101017225) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2012-07-02 |