| NPI | 1154646511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P8261) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01071726A) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2022-04-04 |