| NPI | 1306074778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q7072) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 258007) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2020-03-02 |