| NPI | 1811918766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N1658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM A-1297-05) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2023-09-26 |