| NPI | 1255301834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J8941) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J8941) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2024-03-08 |