| NPI | 1235355330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N6799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301083455) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-11 |