| NPI | 1114594157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD220384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10074451) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-09-30 |