| NPI | 1386885614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P0899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 262040) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2021-06-09 |