| NPI | 1144858390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U5968) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A186747) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-09-14 |