| NPI | 1508273855 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V0133) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 59546) | 
| 207R00000X Internal Medicine (Licence: FL ME146613) | |
| Enumeration Date | 2014-07-18 | 
| Last Update Date | 2025-07-17 |