| NPI | 1770579187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q9863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 3917) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-09-28 |