| NPI | 1871114249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: TX U5503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX U5503) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2025-08-28 |