| NPI | 1386176246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T2746) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 0000061658) |
| 207R00000X Internal Medicine (Licence: TN 0000061658) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-10-13 |