| NPI | 1669684189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M8424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI 6070) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2018-09-18 |