| NPI | 1649590134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 33646) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P3138) |
| 207R00000X Internal Medicine (Licence: TX BP10038066) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2018-05-30 |