| NPI | 1700147683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S0317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 6701) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2024-03-18 |