| NPI | 1578532370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A60048) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T0409) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2023-12-08 |