| NPI | 1689643090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX H9496) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A14225) |
| 207R00000X Internal Medicine (Licence: WA OP60460591) | |
| 207R00000X Internal Medicine (Licence: NM A-1953-16) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2026-03-11 |