| NPI | 1295046837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S2311) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM A-1637-11) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2022-06-20 |