| NPI | 1144668070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q9361) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10046882) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2022-02-26 |