| NPI | 1811995640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX F1300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 43840) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2025-03-14 |