| NPI | 1356964084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V1074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD216992) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2024-08-23 |