| NPI | 1295966695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q7110) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL32981) |
| 207R00000X Internal Medicine (Licence: NC 2012-01348) | |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2024-10-08 |