| NPI | 1174523732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 8215) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K3985) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2025-05-09 |