| NPI | 1578141321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V9924) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME168622) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-08-11 |