| NPI | 1700263134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S2454) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI N608565) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-06-07 |