| NPI | 1003858143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX G7070) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G7070) |
| 207Q00000X Family Medicine (Licence: TX G7070) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-03-12 |