| NPI | 1851786081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V5251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10092149-1205) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2025-01-10 |