| NPI | 1023443371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2019-0145) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q7083) |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2019-07-10 |