| NPI | 1316248503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6221) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125057346) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2020-10-09 |