| NPI | 1629489364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1559) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10049390) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2024-09-19 |