| NPI | 1366544165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-14668) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX K7436) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2022-03-21 |