| NPI | 1760879852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A15089) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R6097) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2021-11-10 |