| NPI | 1316184302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P1994) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10031280) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2024-01-02 |