| NPI | 1861771131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX K9264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 35638) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2025-12-01 |