| NPI | 1952980245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0102051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V2344) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-01-09 |