| NPI | 1679704084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q3746) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS016027) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2022-05-05 |