| NPI | 1205571692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V8373) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R79491) |
| Enumeration Date | 2022-05-01 |
| Last Update Date | 2025-06-30 |