| NPI | 1255998761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V5905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61283087) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2025-05-19 |