| NPI | 1558719625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 26457) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10057606) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2019-08-08 |