| NPI | 1427510064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U6251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP20073434) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2023-11-13 |