| NPI | 1740572551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P7342) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A127745) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2025-07-21 |