| NPI | 1033317565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A112454) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BT23410662951) |
| 207R00000X Internal Medicine (Licence: TX N6423) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2025-09-03 |