| NPI | 1396826855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M4268) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME94544) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-27 |