| NPI | 1043771082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 13485169-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 009701) |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2023-08-23 |