| NPI | 1598394033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U2954) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD61348444) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-05-13 |