| NPI | 1629040654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX MDJ9070) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX 612448) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2020-04-24 |