| NPI | 1194429761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.082380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX W5545) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2026-04-19 |