| NPI | 1063408896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 11907436-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX F7270) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2023-02-06 |