| NPI | 1649777897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V3550) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A163679) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2025-06-02 |