| NPI | 1669868568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R4174) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052475) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2024-05-09 |