| NPI | 1124238191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N5693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L2762) |
| 207R00000X Internal Medicine (Licence: WI WI 52231-20) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-06-27 |