| NPI | 1760844765 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T2227) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0087489) | 
| 207R00000X Internal Medicine (Licence: IA MD-47030) | |
| Enumeration Date | 2016-03-28 | 
| Last Update Date | 2025-07-10 |