| NPI | 1588824973 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R9148) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A103750) | 
| Enumeration Date | 2008-06-10 | 
| Last Update Date | 2025-05-16 |