| NPI | 1053459750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N2257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 224650) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2024-11-07 |