| NPI | 1821393562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL os11150) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL uo1999) |
| 207R00000X Internal Medicine (Licence: TX S8386) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2021-03-30 |