| NPI | 1457351538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX E8793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR R3621) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX E8793) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2025-01-08 |