| NPI | 1720541741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14192720-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102206879) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2026-05-20 |