| NPI | 1669055232 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2024-0285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V5520) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2025-02-12 |