| NPI | 1407346448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T7508) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-00954) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2023-02-22 |