| NPI | 1649775818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V9895) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 329092) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2025-10-09 |