| NPI | 1770111932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U7917) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2022-0663) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-02-27 |