| NPI | 1659807766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U3116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 324184) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2026-02-23 |