| NPI | 1841259413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 14443) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX H3857) |
| 207R00000X Internal Medicine (Licence: VA 0101231497) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2025-03-17 |