| NPI | 1174918874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 10105495-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10105495-8905) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2023-03-15 |