| NPI | 1164775011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX s3341) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 10196A) |
| 207R00000X Internal Medicine (Licence: NE TEP6880) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2023-02-22 |