| NPI | 1083746168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P3254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 16054) |
| 207R00000X Internal Medicine (Licence: LA 12732R) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-03-07 |