| NPI | 1417915521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M9270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M9270) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2025-09-08 |