| NPI | 1831350461 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX 323815) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 42185) | 
| 207R00000X Internal Medicine (Licence: TX P0277) | |
| Enumeration Date | 2008-06-17 | 
| Last Update Date | 2025-06-09 |