| NPI | 1790774321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: TX TX5634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX TX5634) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2022-05-18 |