| NPI | 1417443243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V4084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021025596) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2025-04-01 |