| NPI | 1629087531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M7909) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL L-2456) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-06-02 |