| NPI | 1528350402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 48976) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2025-10-02 |