| NPI | 1093161713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S0916) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P32570) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2021-04-01 |