| NPI | 1770842783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T7706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME149984) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2024-01-20 |