| NPI | 1407550890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W1193) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS T5183) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2026-06-15 |