| NPI | 1922304195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX s9079) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX s9079) |
| 207R00000X Internal Medicine (Licence: PA mt193877) | |
| 207R00000X Internal Medicine (Licence: CO 51132) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2026-04-07 |