| NPI | 1245222033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036108447) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L0459) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2025-08-08 |