| NPI | 1083063267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 12955277-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV DO2438) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2026-01-08 |