| NPI | 1720426059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 78961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S2136) |
| Enumeration Date | 2013-06-09 |
| Last Update Date | 2025-08-07 |