| NPI | 1669035762 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T7566) | 
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: TX T7566) | 
| Enumeration Date | 2019-04-16 | 
| Last Update Date | 2025-09-08 |