| NPI | 1518967686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M5060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 017535) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2021-07-27 |