| NPI | 1316264971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S9848) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 29563) |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2024-06-21 |