| NPI | 1497250336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S3336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA DO-05776) |
| 207R00000X Internal Medicine (Licence: IL 036174448) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2025-09-02 |