| NPI | 1376999748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V1849) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A161899) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2025-06-20 |