| NPI | 1073533956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3816) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AR 15951) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2022-11-08 |