| NPI | 1255858411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W1735) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME175856) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2026-06-04 |