| NPI | 1932215456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.12466R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T9529) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-05-12 |