| NPI | 1336410190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2017004930) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P8168) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2021-01-20 |