| NPI | 1063507382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G80969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K2186) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2024-05-13 |