| NPI | 1588895957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q2913) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT194297) |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2023-03-13 |