| NPI | 1275762411 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207SG0201X Medical Genetics, Clinical Genetics (M.D.) (Licence: TX N3033) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N3033) | 
| Enumeration Date | 2009-07-09 | 
| Last Update Date | 2025-04-09 |