| NPI | 1174266415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101286368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10079242) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2025-06-18 |