| NPI | 1255595435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P0722) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 16252) |
| 207R00000X Internal Medicine (Licence: MO 2011022927) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2021-02-24 |