| NPI | 1609886639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 185519-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 41840) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2026-04-17 |