| NPI | 1912352162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A171059) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S8266) |
| 207R00000X Internal Medicine (Licence: OK 35378) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2025-10-07 |