| NPI | 1871915942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD455829) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R6547) |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2026-08-18 |