| NPI | 1821172354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX E2431) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX E2431) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-12-12 |