| NPI | 1902827322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 187826-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 187826-1205) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-11-27 |