| NPI | 1588278766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U1914) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.076929) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2023-06-27 |