| NPI | 1043605371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R8293) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 66293) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2025-02-19 |