| NPI | 1902365216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 12813168-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-77254) |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2026-07-20 |