| NPI | 1619357209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 311424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R9490) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2019-04-17 |