| NPI | 1699707059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 47817351205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V5692) |
| 207R00000X Internal Medicine (Licence: NV 20468) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-07-07 |