| NPI | 1336889070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME170190) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V3906) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-01-28 |