| NPI | 1720422421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD043981) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10047120) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2019-06-10 |