| NPI | 1689843518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T2305) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 31740) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2023-02-01 |