| NPI | 1023163094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM PA2020-0059) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA03516) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-17 |