| NPI | 1295189330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R9195) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A17118) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2020-07-06 |