| NPI | 1023081411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R9743) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 36705) |
| 207R00000X Internal Medicine (Licence: VA 0101235979) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2019-02-28 |