| NPI | 1609921782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M8095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 47025) |
| 207R00000X Internal Medicine (Licence: IA 35611) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2023-09-12 |