| NPI | 1821674698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 103717) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V6027) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-03-18 |