| NPI | 1356126007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W6570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2023034568) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2026-08-27 |