| NPI | 1679194013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101282167) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX U7511) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2024-06-13 |