| NPI | 1780612226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J4476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 42167) |
| 207R00000X Internal Medicine (Licence: ME 14868) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-09-30 |