| NPI | 1639330327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 261805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R0537) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2023-04-17 |