| NPI | 1497442487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX 764926) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 764926) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2024-10-21 |