| NPI | 1649293689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M7087) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 247048) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-09-17 |