| NPI | 1578889556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S7932) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 271710) |
| 207R00000X Internal Medicine (Licence: GA 072409) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2025-09-29 |