| NPI | 1457843229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX 2742) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD226419) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2025-09-23 |