| NPI | 1740351048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L9071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-114316) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2018-09-19 |