| NPI | 1942254842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX K6497) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K6497) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2026-09-11 |