| NPI | 1629065776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036091613) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-03-08 |