| NPI | 1407598311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V6983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 747262) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2025-08-15 |