| 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 |