| NPI | 1316444755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V6741) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 89672) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2025-07-08 |