| NPI | 1700170867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S7496) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 49383) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: TX S7496) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2025-01-21 |