| NPI | 1659639607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R7139) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 142039) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2023-11-14 |