| NPI | 1841678349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX BP10052893) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R5259) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2018-07-11 |