| NPI | 1649833237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2023019628) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T6979) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2026-07-28 |