| NPI | 1447787171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A169495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10060326) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2025-12-13 |