| NPI | 1841289030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L7274) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 22315) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2024-09-18 |