| NPI | 1104443118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: TX W0841) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01090213A) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2026-03-02 |