| NPI | 1396161733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R8643) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT205448) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2025-06-17 |