| NPI | 1639602535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U1697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020022051) |
| 207R00000X Internal Medicine (Licence: VA 0101269097) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2023-08-18 |