| NPI | 1336290444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 69096) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 51697) |
| 207R00000X Internal Medicine (Licence: TX R2759) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2023-11-13 |