| NPI | 1205285053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S2153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10055348) |
| Enumeration Date | 2016-06-11 |
| Last Update Date | 2023-03-08 |