| NPI | 1588741078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD70041686) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M5039) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: TX M5039) | |
| 208D00000X General Practice (Licence: TX M5039) | |
| 207R00000X Internal Medicine (Licence: TX M5039) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX M5039) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-10-08 |