| NPI | 1912254145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P9962) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 567310) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2025-03-31 |