| NPI | 1487394912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A207208) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V6084) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-07-28 |