| NPI | 1083243703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 78802) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX U4878) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2025-01-14 |