| NPI | 1124173513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N9669) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 40637) |
| 207R00000X Internal Medicine (Licence: MD P20421) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2024-01-16 |