| NPI | 1528487907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 67591) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10049496) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2020-07-08 |