| NPI | 1780786236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M7617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD429861) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2020-05-11 |