| NPI | 1215976865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2012-0412) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX H0259) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2025-01-30 |