| NPI | 1831571363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 10627984-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 207R00000X) |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2025-06-20 |