| NPI | 1639604515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V0943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 56750) |
| 207R00000X Internal Medicine (Licence: FL ME145022) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2026-01-12 |