| NPI | 1649563925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q7922) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME120615) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2026-01-14 |