| NPI | 1023792249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W7745) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10084433) |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2026-07-13 |