| NPI | 1679936074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01087599A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10056212) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2022-06-24 |