| NPI | 1689310492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0103389) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10079531) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2025-05-20 |