| NPI | 1205450178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V0479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL84280) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2025-01-06 |