| NPI | 1811900285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M5606) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 241447) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-10-09 |