| NPI | 1467157305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14244573-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R80180) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2025-10-29 |