| NPI | 1831475136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A13311) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P8058) |
| 207R00000X Internal Medicine (Licence: TX L0103652-0328) | |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2021-09-16 |