| NPI | 1669884573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 295807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R2508) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2022-08-04 |