| NPI | 1790487643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 345177) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX W5731) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2026-06-24 |